Materials > Checklists > Other Institutions' Modified Checklists
The WHO's checklist is not intended to be comprehensive, and additions and modifications to fit local practice are encouraged. Nonetheless, modification of the checklist should be undertaken with a critical eye. Click here for guidelines on how to modify the checklist. Examples of modified checklists from hospitals around the world can be found below. To create your own, please use this handy Word template.
To view only those surgical safety checklists developed for specific procedures or specialties, click here.
Argentina
Australia
Bahrain
Canada
Kirkland and District Hospital -- Surgical Checklist
Kirkland and District Hospital -- Cataracts Checklist
Kirkland and District Hospital -- Endoscopy Checklist
Northern Lights Health Center, Fr. McMurray
Regina-Qu'Appelle Health Region -- Cataract/Plastics, Ophthalmology Checklist
Regina-Qu'Appelle Health Region -- Hysteroscopy Checklist
Surrey Memorial Hospital
University Health Network Hospital, Toronto
Woodstock Hospital, Ontario -- Cataract Checklist
Woodstock Hospital, Ontario -- Endoscopy Checklist
Woodstock Hospital, Ontario -- Major Anesthesia Surgery Checklist
Woodstock Hospital, Ontario -- Minor Anesthesia Surgery Checklist
Kirkland and District Hospital -- Cataracts Checklist
Kirkland and District Hospital -- Endoscopy Checklist
Northern Lights Health Center, Fr. McMurray
Regina-Qu'Appelle Health Region -- Cataract/Plastics, Ophthalmology Checklist
Regina-Qu'Appelle Health Region -- Hysteroscopy Checklist
Surrey Memorial Hospital
University Health Network Hospital, Toronto
Woodstock Hospital, Ontario -- Cataract Checklist
Woodstock Hospital, Ontario -- Endoscopy Checklist
Woodstock Hospital, Ontario -- Major Anesthesia Surgery Checklist
Woodstock Hospital, Ontario -- Minor Anesthesia Surgery Checklist
Finland
Germany
Italy
India
Japan
Kuwait
Malaysia
Mozambique
Niger
Philippines
Portugal
Saudi Arabia
Sierra Leone
South Africa
Spain
Sweden
Switzerland
Thailand
United Kingdom
Great Ormond Street Hospital for Children
Milton Keynes Hospital
National Patient Safety Agency's Surgical Safety Checklist
National Patient Safety Agency's Radiology Checklist
Royal Brompton Hospital, London
Royal College of Ophthalmologists and the National Patient Safety Agency's Cataract Surgery Checklist
Milton Keynes Hospital
National Patient Safety Agency's Surgical Safety Checklist
National Patient Safety Agency's Radiology Checklist
Royal Brompton Hospital, London
Royal College of Ophthalmologists and the National Patient Safety Agency's Cataract Surgery Checklist
Uruguay
United States
American Association of Peri-operative Nursing Association (AORN)
Baptist Memorial Health Care Corporation
Blue Cross Blue Shield Association
Brigham and Women's Hospital, Boston, Massachusetts
Children's Hospital, Boston -- Surgical Safety Checklist
Children's Hospital, Boston -- Bedside Safety Checklist
Children's Hospital, Boston -- Procedural Safety Checklist
Colorado Hospital Association, Colorado -- Checklist
Colorado Hospital Association, Colorado -- Implementation Manual
Fairview Hospital, Great Barrington, Massachusetts
Gundersen Lutheran Health System, Wisconsin
Institute for Healthcare Improvement (Template)
Kona Community Hospital, Hawaii
Loma Linda University Medical Center, California
Mayo Clinic, Rochester, Minnesota
NEA Baptist Memorial Hospital, Arkansas--Catheterization Laboratory Checklist
NEA Baptist Memorial Hospital, Arkansas--Radiology Checklist
NEA Baptist Memorial Hospital, Arkansas--GI Checklist
Oregon Hospital Association -- Ambulatory Checklist
Oregon Hospital Association -- Surgical Checklist
Regions Hospital, St. Paul Minnesota
Society of Thoracic Surgeons -- Adult Cardiac Surgery
Society of Thoracic Surgeons -- General Thoracic Surgery
Society of Thoracic Surgeons -- Congenital Heart Surgery
Surgical Clinical Outcomes Assessment Program, Washington State
St. Joseph's Hospital, Denver, Colorado
Stanford Hospital and Clinics, California
UNC Labor and Delivery Checklist, North Carolina
United Health Services, New York
Veterans Health Administration
Baptist Memorial Health Care Corporation
Blue Cross Blue Shield Association
Brigham and Women's Hospital, Boston, Massachusetts
Children's Hospital, Boston -- Surgical Safety Checklist
Children's Hospital, Boston -- Bedside Safety Checklist
Children's Hospital, Boston -- Procedural Safety Checklist
Colorado Hospital Association, Colorado -- Checklist
Colorado Hospital Association, Colorado -- Implementation Manual
Fairview Hospital, Great Barrington, Massachusetts
Gundersen Lutheran Health System, Wisconsin
Institute for Healthcare Improvement (Template)
Kona Community Hospital, Hawaii
Loma Linda University Medical Center, California
Mayo Clinic, Rochester, Minnesota
NEA Baptist Memorial Hospital, Arkansas--Catheterization Laboratory Checklist
NEA Baptist Memorial Hospital, Arkansas--Radiology Checklist
NEA Baptist Memorial Hospital, Arkansas--GI Checklist
Oregon Hospital Association -- Ambulatory Checklist
Oregon Hospital Association -- Surgical Checklist
Regions Hospital, St. Paul Minnesota
Society of Thoracic Surgeons -- Adult Cardiac Surgery
Society of Thoracic Surgeons -- General Thoracic Surgery
Society of Thoracic Surgeons -- Congenital Heart Surgery
Surgical Clinical Outcomes Assessment Program, Washington State
St. Joseph's Hospital, Denver, Colorado
Stanford Hospital and Clinics, California
UNC Labor and Delivery Checklist, North Carolina
United Health Services, New York
Veterans Health Administration
Has your institution created its own modified checklist? Please share it with us! Please send it as an attachment in an email to safesurgery@hsph.harvard.edu and indicate whether you give permission for us to share it on our website.